Provider Demographics
NPI:1568712545
Name:LEE, SUZANNE MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MAE
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MAE
Other - Last Name:VLCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1505 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3321
Mailing Address - Country:US
Mailing Address - Phone:510-316-5680
Mailing Address - Fax:
Practice Address - Street 1:1505 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3321
Practice Address - Country:US
Practice Address - Phone:510-316-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor